International Journal for Equity in Health 2012, 11:81
doi:10.1186/1475-9276-11-81

Published: 18 December 2012

Abstract

Introduction

A recent health reform was implemented in Chile (the AUGE reform) with the objective
of reducing the socioeconomic gaps to access healthcare. This reform did not seek
to eliminate the private insurance system, which coexists with the public one, but
to ensure minimum conditions of access to the entire population, at a reasonable cost
and with a quality guarantee, to cover an important group of health conditions. This
paper’s main objective is to enquire what has happened with the use of several healthcare
services after the reform was fully implemented.

Methods

Concentration and Horizontal Inequity indices were estimated for the use of general
practitioners, specialists, emergency room visits, laboratory and x-ray exams and
hospitalization days. The change in such indices (pre and post-reform) was decomposed,
following Zhong (2010). A “mean effect” (how these indices would change if the differential
use in healthcare services were evenly distributed) and a “distribution effect” (how
these indices would change with no change in average use) were obtained.

Results

Changes in concentration indices were mainly due to mean effects for all cases, except
for specialists (where “distribution effect” prevailed) and hospitalization days (where
none of these effects prevailed over others). This implies that by providing more
services across socioeconomic groups, less inequality in the use of services was achieved.
On the other hand, changes in horizontal inequity indices were due to distribution
effects in the case of GP, ER visits and hospitalization days; and due to mean effect
in the case of x-rays. In the first three cases indices reduced their pro-poorness
implying that after the reform relatively higher socioeconomic groups used these services
more (in relation to their needs). In the case of x-rays, increased use was responsible
for improving its horizontal inequity index.

Conclusions

The increase in the average use of healthcare services after the AUGE reform has not
always led to improved equity in the use of such services in most services. This indicates
that there are still barriers to the equitable use of healthcare services (e.g. insufficient
medical human resources, financial barriers, capacity constraints, etc.) that have
remained after the reform.